Matching Digital Intervention Affordances with Tasks: The Case of a Zoom and WhatsApp Mental Health Intervention for Seniors during the COVID-19 Pandemic.

During the first COVID-19 wave, we conducted a Zoom and WhatsApp digital group intervention that promoted community-dwelling seniors' mental health. A total of 82 community-dwelling adults participated in this intervention. Based on the media richness theory (MRT) and the affordances approach, we used netnography to explore how group moderators and technical support team members (n = 9), but not the seniors themselves, perceived the ways Zoom and WhatsApp technological affordances/constraints matched intervention tasks and increased intervention performance. We identified four Zoom and WhatsApp affordances: temporality, interactivity, multimediality, and portability. Empirically, our findings represent a first step in creating a conceptual framework for analyzing digital intervention performances that addresses users' perceptions of technologies and intervention goals. Theoretically, our synergic analysis of MRT and the affordances approach offers a cohesive framework that shifts from a focus on users' interactions with one type of media to their interactions with all media that are used in attaining intervention goals.

A Digital Intervention to Alleviate Loneliness and Depression Among Older Persons During the COVID-19 Outbreak

Social distancing has been proven to be effective in reducing infections but may cause ill effects on the mental health of older adults. We evaluated the effects of a short-term virtual group intervention that provided tools to promote better coping, and mitigate adverse mental health effects during the outbreak of the covid-19 pandemic. A Randomized controlled trial tested the effects of a guided intervention comprised of seven online group sessions in which cognitive-behavioral techniques targeting maladaptive beliefs and appraisals were learned and practiced via ZOOM. A total of 82 community-dwelling adults from Israel, aged between 65 - 90 were randomized to either an intervention group (n=64) or a wait-list control group (n=18). Loneliness (UCLA loneliness scale) and depressive symptoms (PHQ-9) were measured pre-intervention, post-intervention, and at 1-month follow-up. The findings showed a significant decrease in loneliness and depression scores in the intervention group with results maintained at 1-month follow-up. There were no significant changes in the wait-list control group. In addition, ten participants (16%) from the intervention group demonstrated a clinically meaningful decrease in depression between baseline and post-intervention, and this was maintained among 7 participants (10%) at 1-month follow-up, compared to only 1 participant (5%) in the control group. Our intervention presents a simple and easy-to-implement tool. Its relevance extends beyond the current pandemic as the skills acquired can be applied in other forms of social crises and during routine life, in order to promote the mental health of older adults who live alone and/or reside in remote areas.

Age and Ageing During the COVID-19 Pandemic; Challenges to Public Health and to the Health of the Public.

The distribution of the SARS-CoV-2 virus has reached pandemic proportions. While COVID-19 can affect anyone, it is particularly hazardous for those with "co-morbidities." Older age is an especially strong and independent risk factor for hospital and ICU admission, mechanical ventilation and death. Health systems must protect persons at any age while paying particular attention to those with risk factors. However, essential freedoms must be respected and social/psychological needs met for those shielded. The example of the older population in Israel may provide interesting public health lessons. Relatively speaking, Israel is a demographically young country, with only 11.5% of its population 65 years and older as compared with the OECD average of >17%. As well, a lower proportion of older persons is in long-term institutions in Israel than in most other OECD countries. The initiation of a national program to protect older residents of nursing homes and more latterly, a successful vaccine program has resulted in relatively low rates of serious COVID-19 related disease and mortality in Israel. However, the global situation remains unstable and the older population remains at risk. The rollout of efficacious vaccines is in progress but it will probably take years to cover the world's population, especially those living in low- and middle-income countries. Every effort must be made not to leave these poorer countries behind. Marrying the principles of public health (care of the population) with those of geriatric medicine (care of the older individual) offers the best way forward.

Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy.

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC's activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society's vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.

Evaluation of a Short-Term Digital Group Intervention to Relieve Mental Distress and Promote Well-Being Among Community-Dwelling Older Individuals During the COVID-19 Outbreak: A Study Protocol.

Older individuals are at an increased risk of experiencing adverse social and health consequences due to both the COVID-19 pandemic and the measures taken to manage it, such as social distancing. To promote community-dwelling older individuals' well-being during this time, the aims of the current project are to develop effective strategies in order (a) to increase older individuals' digital literacy, and (b) to help them acquire behavioral and cognitive skills that will improve their coping abilities with the stressful situation created as a result of the pandemic, as well as reducing adverse mental health effects. The project comprises an intervention arm that includes digital group sessions for older individuals meant to improve their digital literacy, promote their effective coping, and relieve their mental distress and loneliness. Subjects receive a short-term (seven sessions), twice-weekly, digitally guided group intervention through Zoom (a video conferencing app), and WhatsApp (instant messaging app). The wait list control-group participants receive twice-weekly telephone calls from a research assistant during a parallel period. Web-based questionnaires are filled in pre- and post-participation. The effectiveness of the intervention will be analyzed by comparing pre- and post-measures, between intervention and control groups. This protocol offers a model for helping to support vulnerable populations during the COVID-19 pandemic. However, it is applicable regardless of the outbreak of a global health crisis or the imposition of lockdown rules; in fact, it has the potential to contribute to the social inclusion of vulnerable populations during routine times as well as during emergencies. Furthermore, ideas for future expansion include the integration of multilingual facilitators in order to reach seniors from underserved minority groups in various social contexts, even across borders.

A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak.

While effective in reducing infections, social distancing during the COVID-19 outbreak may carry ill effects on the mental health of older adults. The present study explored the efficacy of a short-term digital group intervention aimed at providing seniors with the tools and skills necessary for improving their coping ability during these stressful times. A total of 82 community-dwelling adults aged between 65 aged 90 (Mage = 72 years, SD = 5.63) were randomized to either an intervention group (n = 64) or a wait-list control group (n = 18). The intervention comprised online guided sessions in small groups in which behavioral and cognitive techniques were learned and practiced via the ZOOM videoconferencing platform. Loneliness and depression levels were measured pre- and post-participation. The results demonstrated a significant improvement in the intervention group in terms of both loneliness and depressive symptoms, compared with the control group. Results of mixed effect models indicated a medium ameliorative effect on loneliness (d = 0.58), while that for depressive symptoms was only marginally significant and smaller in size (d = 0.43). Our intervention presents a relatively simple and effective technique that can be efficiently utilized to support older adults both during emergencies such as the COVID-19 outbreak, as well as in more routine times for older adults who live alone or reside in remote areas.

Age, ageing, ageism and "age-itation" in the Age of COVID-19: rights and obligations relating to older persons in Israel as observed through the lens of medical ethics.

COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various "co-morbidities" such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel's population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country's (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency.An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not "social") distancing without exacerbating an older person's sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a "double pandemic" this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person's wish to "make way" for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population's need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.

Israel Ad Hoc COVID-19 Committee: Guidelines for Care of Older Persons During a Pandemic.

Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID-19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long-term care institutions, a triage instrument, and palliative care. Patient autonomy was emphasized, with a strong recommendation for people of all ages to update their advance directives or, if they did not have any, to quickly draw them up. Considering the value of distributive justice, with respect to triage, a "soft utilitarian" approach was advocated with the main criteria being function and comorbidity. Although chronological age was rejected as a sole criterion, in the case of an overwhelming crisis, "biological age" would enter into the triage considerations, but only in the case of distinguishing between people with equal non-age-related deficits. The guideline emphasized that no matter what, in the spirit of beneficence, anyone who fell ill must receive active palliative care throughout the course of a COVD-19 infection but especially at the end of life. Furthermore, in the spirit of nonmaleficence, the frail, very old, and severely demented would be actively protected from dying on ventilation. J Am Geriatr Soc 68:1370-1375, 2020.